Healthcare Provider Details

I. General information

NPI: 1639966740
Provider Name (Legal Business Name): PAIN AND REHAB ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2025
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7134 S YALE AVE STE 500
TULSA OK
74136-6352
US

IV. Provider business mailing address

PO BOX 700701
TULSA OK
74170-0701
US

V. Phone/Fax

Practice location:
  • Phone: 918-841-2466
  • Fax:
Mailing address:
  • Phone: 918-841-2466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: TYLER RHODES
Title or Position: ADMIN
Credential:
Phone: 918-740-3473